198007594-4-5-2022-33-CC-NTCG-CD7R2T-20220405123853

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198007594
Report Date: 04/05/2022
Date Signed: 04/05/2022 12:39:04 PM

Document Has Been Signed on 04/05/2022 12:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	ESQUIVEL FAMILY CHILD CARE		FACILITY NUMBER:	198007594
ADMINISTRATOR:	ESQUIVEL, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 807-3037
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	14	CENSUS: 11	DATE:	04/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:06 AM
MET WITH:	Maria Esquivel - Licensee		TIME COMPLETED:	12:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced annual random inspection to the above facility. At 11:06am, LPA met with licensee, Maria Esquivel. Also present during this inspection, is licensee's two assistants. The licensee states that she currently has 12 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 7am-5pm, Monday-Friday. This is a one-story home which consists of 2 bedrooms, 1 bathroom, kitchen, dining room, living room, laundry room, garage and side yard (fenced). The children use bedroom #1 (infant room), bathroom, living room, dining room area and side yard. Per licensee, areas off limits to children and parents include: Licensee's bedroom, kitchen, laundry room, and garage. The licensee provides food for children in care. The licensee states that 2 adults and 1 child currently live in the home. Persons living in home are identified on the attached LIC811. Licensee states that she currently has two assistants. Staff are identified on the attached LIC859 All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises. PHYSICAL PLANT At 11:15am, LPA was lead on a tour of the facility by the licensee. The front entrance leads into the living room where there are age appropriate toys and equipment for children in care to use. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. The dining room is right next to the living room and has books and an eating area for children in care. The infant room was reviewed next. there are two cribs available, as well as a changing table for infants in care. LPA observed napping equipment in the form of cots. Equipment is stored in infant room and are individually stored and labeled. Per licensee, the infant room will be used as an area for an ill child until an authorized representative comes to pick up child. REPORT CONTINUES PAGE 1 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ESQUIVEL FAMILY CHILD CARE	FACILITY NUMBER: 198007594
	VISIT DATE: 04/05/2022

NARRATIVE

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The bathroom was reviewed and was observed to be safe, clean and free of any hazards. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children and are observed to be high up above a cabinet. LPA also observed the cabinet under the sink to have a child safety lock. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. At 11:23am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 03/02/2022, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. There are first aid supplies available. The licensee states that a cell phone is used and stays at the facility during operating hours but they do have a landline as well on the premises. Smoke and carbon monoxide detectors were tested and are operable.

At 11:25am, LPA observed the outdoor area. The outdoor play area was observed to be fenced. At this time, children are using the side yard for outdoor play time. LPA observed there to be age appropriate toys and equipment present for children in care. The outdoor area was observed to be safe, clean, and free of any hazards. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 03/2024. Licensee and other personnel have complete mandated reporter training that expires on 01/19/2024. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

The following was discussed:

-Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.
-There are no pets on the premises.
-Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home.
REPORT CONTINUES PAGE 2 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ESQUIVEL FAMILY CHILD CARE	FACILITY NUMBER: 198007594
	VISIT DATE: 04/05/2022

NARRATIVE

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Infant Care: Licensee states that they are currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. Licensee states that infants sleep in the infant room. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection.

Incidental Medical Services (IMS):

The licensee states that she is providing IMS at this time (see LIC811 or LIC857 for child information).
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA observed that a COVID-19 Technical Assistance call had been made on 05/04/2021. LPA observed health and safety practices being conducted at facility.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative.

Exit interview was conducted with Maria Esquivel, Licensee, at 12:40pm. Copy of report was provided.

REPORT ENDS PAGE 3 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022

LIC809 (FAS) - (06/04)

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